MEDICARE: CHICAGO LAB SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0006X	Clinical Pathology Physician
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1902416936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO LAB SERVICES INC

Provider Business Mailing Address
First Line	:	7422 N WESTERN AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1707
Country	:	US
Telephone Number	:	773-274-3418
Fax Number	:	773-856-6829

Provider Business Practice Location Address
First Line	:	7422 N WESTERN AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1707
Country	:	US
Telephone Number	:	773-274-3418
Fax Number	:	773-856-6829

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SHAISTA HABIB
Credential	:	M.S
Telephone Number	:	630-788-0870

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	04/07/2023

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Directions to “CHICAGO LAB SERVICES INC ” Practice Location

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